Renal Replacement Therapy In Patients Research Articles

Protein carbonyl concentration as a biomarker for development and mortality in sepsis-induced acute kidney injury.

The objective of the present study was to evaluate protein carbonyl concentration as a predictor of AKI development in patients with septic shock and of renal replacement therapy (RRT) and mortality in patients with SAKI. This was a prospective observational study of 175 consecutive patients over the age of 18 years with septic shock upon Intensive Care Unit (ICU) admission. After exclusion of 46 patients (27 due to AKI at ICU admission), a total of 129 patients were enrolled in the study. Demographic information and blood samples were taken within the first 24 h of the patient’s admission to determine serum protein carbonyl concentrations. Among the patients who developed SAKI, the development of AKI was evaluated, along with mortality and need for RRT. The mean age of the patients was 63.3 ± 15.7 years, 47% were male and 51.2% developed SAKI during ICU stay. In addition, protein carbonyl concentration was shown to be associated with SAKI. Among 66 patients with SAKI, 77% died during the ICU stay. Protein carbonyl concentration was not associated with RRT in patients with SAKI. However, the ROC curve analysis revealed that higher levels of protein carbonyl were associated with mortality in these patients. In logistic regression models, protein carbonyl level was associated with SAKI development (OR: 1.416; 95% CI: 1.247–1.609; P<0.001) and mortality when adjusted by age, gender, and APACHE II score (OR: 1.357; 95% CI: 1.147–1.605; P<0.001). In conclusion, protein carbonyl concentration is predictive of AKI development and mortality in patients with SAKI, with excellent reliability.

Renal Replacement Therapy In Patients With Cervical Cancer Complicated By Acute Renal Failure

Renal Replacement Therapy In Patients With Cervical Cancer Complicated By Acute Renal Failure

Pancreatic transplantation for diabetic patients with end-stage renal failure: a brief review

Renal transplant, undoubtedly, is the most physiological renal replacement therapy for patients with end-stage kidney disease (ESRD). It enhances patient’s quality of life and improves expectancy when compared with dialysis therapy. However, diabetic kidney transplant recipients can have progressive diabetic nephropathy in renal allograft and other complications of diabetes resulting in relatively inferior patient and graft survival in comparison with nondiabetic patients with ESRD. Currently, the pancreatic-kidney transplant has proven to be a very good option in selected patients with ESRD with type-1 diabetes mellitus, that is, insulin-dependent diabetes mellitus, and further smaller number of patients with ESRD with type-2 diabetes mellitus, that is, noninsulin-dependent diabetes mellitus. The aim of pancreatic transplantation is to enhance the quality of life, improve allograft and patient survival and to reverse some of the microvascular complications associated with diabetes.

THE INFLUENCE OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUES ON DEPRESSION LEVEL OF CRONIC KIDNEY DISEASE PATIENT UNDERGOING HEMODIALYSIS THERAPY

Hemodialysis is a renal replacement therapy for patients with cronic renal disease who are decline of renal fuction. The complex therapy and physical condition of chronic kidney disease and hemodialysis patient involve a severe stressor that lead to depression. Progressive muscle relaxation technique is one of nonpharmacoloical therapies that treat depression. This research aimed to prove the influence of progressive muscle relaxation technique to changes in depression level in cronic kidney disease with hemodialysis in Dr. WahidinSudiroHusodoMojokertohospital. In this research design used is Quasy experiment with pre-test post-test control group design. Sample of 30 people were taken by simple random sampling. 15 people from experimental group were given routine progressive muscle relaxation technique in 2 times a day of the week and 15 people from control group were given not routine progressive muscle relaxation techniques in 2 day one time in a week . The research instrument was Beck Depression Inventory. Wilcoxon Signed Rank Test shows that p value (0.001) &lt; α (0.05), so it is accepted that there is an effect of progressive muscle relaxation on the depression level of cronic kidney disease patient undergoing hemodialysis. To test the U-Mann Whitney shows that p value (0.005) &lt; α (0.05), so that H0 is rejected it means there is different of the channge depression level between experiment group and the control group.this therapy can increase the production of melatonin and serotonin, reduce stress hormone cortisol. PMR also, lowering the muscle tension ,do make positive thinking so, throught that is influence to decrease in depression level. Routine muscle relaxationdistractify the stressor everyday in training.

THE INFLUENCE OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUES ON DEPRESSION LEVEL OF CRONIC KIDNEY DISEASE PATIENT UNDERGOING HEMODIALYSIS THERAPY

Hemodialysis is a renal replacement therapy for patients with cronic renal disease who are decline of renal fuction. The complex therapy and physical condition of chronic kidney disease and hemodialysis patient involve a severe stressor that lead to depression. Progressive muscle relaxation technique is one of nonpharmacoloical therapies that treat depression. This research aimed to prove the influence of progressive muscle relaxation technique to changes in depression level in cronic kidney disease with hemodialysis in Dr. WahidinSudiroHusodoMojokertohospital. In this research design used is Quasy experiment with pre-test post-test control group design. Sample of 30 people were taken by simple random sampling. 15 people from experimental group were given routine progressive muscle relaxation technique in 2 times a day of the week and 15 people from control group were given not routine progressive muscle relaxation techniques in 2 day one time in a week . The research instrument was Beck Depression Inventory. Wilcoxon Signed Rank Test shows that p value (0.001) &lt; α (0.05), so it is accepted that there is an effect of progressive muscle relaxation on the depression level of cronic kidney disease patient undergoing hemodialysis. To test the U-Mann Whitney shows that p value (0.005) &lt; α (0.05), so that H0 is rejected it means there is different of the channge depression level between experiment group and the control group.this therapy can increase the production of melatonin and serotonin, reduce stress hormone cortisol. PMR also, lowering the muscle tension ,do make positive thinking so, throught that is influence to decrease in depression level. Routine muscle relaxationdistractify the stressor everyday in training.

Complications of regional citrate anticoagulation: accumulation or overload?

Regional citrate anticoagulation (RCA) is now recommended over systemic heparin for continuous renal replacement therapy in patients without contraindications. Its use is likely to increase throughout the world. However, in the absence of citrate blood level monitoring, the diagnosis of citrate accumulation, the most feared complication of RCA, remains relatively complex. It is therefore commonly mistaken with other conditions. This review aims at providing clarifications on RCA-associated acid-base disturbances and their management at the bedside. In particular, the authors wish to propose a clear distinction between citrate accumulation and net citrate overload.

Dissolved molecular hydrogen (H2) in Peritoneal Dialysis (PD) solutions preserves mesothelial cells and peritoneal membrane integrity

BackgroundPeritoneal dialysis (PD) is used as renal replacement therapy in patients with end-stage kidney disease. However, peritoneal membrane failure remains problematic and constitutes a critical cause of PD discontinuation. Recent studies have revealed the unique biological action of molecular hydrogen (H2) as an anti-oxidant, which ameliorates tissue injury. In the present study, we aimed to examine the effects of H2 on the peritoneal membrane of experimental PD rats.MethodEight-week-old male Sprague-Dawley rats were divided into the following groups (n = 8–11 each) receiving different test solutions: control group (no treatment), PD group (commercially available lactate-based neutral 2.5% glucose PD solution), and H2PD group (PD solution with dissolved H2 at 400 ppb). Furthermore, the influence of iron (FeCl3: 5 μM: inducer of oxidative cellular injury) in the respective PD solutions was also examined (Fe-PD and Fe-H2PD groups). The H2PD solution was manufactured by bathing a PD bag in H2-oversaturated water created by electrolysis of the water. Twenty mL of the test solutions were intraperitoneally injected once a day for 10 days. Parietal peritoneum samples and cells collected from the peritoneal surface following treatment with trypsin were subjected to analysis.ResultsIn the PD group as compared to controls, a mild but significant sub-mesothelial thickening was observed, with increase in the number of cells in the peritoneal surface tissue that were positive for apoptosis, proliferation and vimentin, as seen by immunostaining. There were significantly fewer of such changes in the H2PD group, in which there was a dominant presence of M2 (CD163+) macrophages in the peritoneum. The Fe-PD group showed a significant loss of mesothelial cells with sub-mesothelial thickening, these changes being ameliorated in the Fe-H2PD group.ConclusionH2-dissolved PD solutions could preserve mesothelial cells and peritoneal membrane integrity in PD rats. Clinical application of H2 in PD could be a novel strategy for protection of peritoneal tissue during PD treatment.

Prognostic value of cell cycle arrest biomarkers in patients at high risk for acute kidney injury: A systematic review and meta-analysis.

Urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) are G1 cell cycle arrest biomarkers. This systematic review aimed to evaluate the prognostic value of urinary [TIMP-2]·[IGFBP7] in patients at high risk for AKI. The MEDLINE (via PubMed), Ovid, EMBASE and Cochrane Library databases were systematically searched from inception to December 25, 2016. Original clinical studies which met the eligibility criteria were included in this study. The prognostic accuracy of urinary [TIMP-2]·[IGFBP7] for assessing the need for renal replacement therapy (RRT) and mortality was evaluated by pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curves. A total of four prospective cohort studies evaluating 277 patients were included. The estimated area under the receiver operating characteristic curve (AUC) of urinary [TIMP-2]·[IGFBP7] for predicting the need for RRT in patients at high risk for AKI was 0.915 (standard error [SE] = 0.040). Pooled sensitivity and specificity with corresponding 95% confidence intervals (CI) were 0.69 (95% CI 0.53-0.82) and 0.81 (95% CI 0.75-0.86), respectively. Urinary [TIMP-2]·[IGFBP7] for mortality prediction in patients at high risk for AKI was assessed by qualitative description. Based on the above data, urinary [TIMP-2]·[IGFBP7] performs well in predicting the need for RRT and mortality in patients at high risk for AKI. However, further meta-analyses are warranted as more data become available.

Early versus late initiation of renal replacement therapy in patients with acute kidney injury: a meta-analysis of randomised clinical trials.

The optimal timing of renal replacement therapy (RRT) initiation in acute kidney injury (AKI) remains a matter of debate. A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to better estimate the effects of early initiation of RRT compared with late initiation of RRT among patients with AKI and in patients at risk for AKI. A Medline literature research was conducted in PubMed for RCTs in adult patients with AKI that compared different RRT initiation strategies (early vs late). The meta-analysis outcomes were in-hospital or ≤60 day mortality, and renal recovery. Nine trials meeting inclusion criteria and four trials investigating preventive dialysis in patients at risk for AKI were identified. Early initiation of RRT was not associated with reduced in-hospital or 60-day mortality: risk ratio (RR) 0.91, 95% confidence interval (CI) 0.72-1.16, p = 0.46, I2 = 49%). When only the four trials that offered RRT within 6 to 12 hours of eligibility were included in the analysis, the results were similar (RR 0.93, 95% CI 0.82-1.06) without significant heterogeneity. The percentage of patients among survivors who recovered enough kidney function to be off dialysis was similar with early compared with late RRT: RR 1.02, 95% CI 0.99-1.06, p = 0.16. Early initiation of RRT was associated with higher incidence of catheter-related infections: RR 1.82, 95% CI 1.03-3.21, p = 0.04. No survival benefit was identified in patients undergoing preventive dialysis: RR 0.85 (95% CI 0.52-1.41, p = 0.54). Early RRT in patients with AKI (or at risk for AKI) does not appear to provide a significant reduction in mortality rates compared with late RRT. The data did not suggest any apparent impact on renal recovery with early dialysis.

TCT-474 Ultra-Low Contrast Coronary Angiography in Patients with Advanced Chronic Kidney Disease - Feasibility and Outcomes Compared to Standard Angiography

Patients with advanced chronic kidney disease (CKD) have avoided diagnostic coronary angiography due to concerns of precipitating the need for renal replacement therapy (RRT). Our objective was to establish the risk of contrast-induced nephropathy (CIN) and need for RRT in patients with advanced CKD

Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy.

BackgroundPatients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT.MethodsCases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine <2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed.ResultsPatients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09–4.68; P = .03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%–74%) chance of a worse disposition outcome.ConclusionsChronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.

A comparison of early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials

BackgroundTo investigate the impact of timing the initiation of renal replacement therapy (RRT) on clinical outcomes in critically ill patients with acute kidney injury (AKI), focusing on the randomized controlled trials (RCTs) in this field.MethodsThe PubMed, EMBASE and Cochrane databases were searched between January 1, 1985, and June 30, 2016, to identify randomized trials that assessed the timing of initiation of RRT in patients with AKI.ResultsNine RCTs, with a total of 1636 patients, were enrolled in this meta-analysis. A pooled analysis of the studies indicated no mortality benefit with “early” RRT, with an RR of 0.98 (95% CI 0.78 to 1.23, P = 0.84). There was no significant difference in intensive care unit (ICU) length of stay (LOS) or hospital LOS between the early and late RRT groups for survivors or nonsurvivors. Pooled analysis also demonstrated no significant change in renal function recovery (RR 1.02, 95% CI 0.88 to 1.19, I2 = 59%), RRT dependence (RR 0.76, 95% CI 0.42 to 1.37, I2 = 0%), duration of RRT (Mean difference 1.43, 95% CI -1.75 to 4.61, I2 = 78%), renal recovery time (Mean difference 0.73, 95% CI -2.09 to 3.56, I2 = 70%) or mechanical ventilation time (Mean difference − 0.95, 95% CI -3.54 to 1.64, I2 = 64%) between the early and late RRT groups. We found no significant differences in complications between the groups.ConclusionsOur meta-analysis revealed that the “early” initiation of RRT in critically ill patients did not result in reduced mortality. Pooled analysis of secondary outcomes also showed no significant difference between the early and late RRT groups. More well-designed and large-scale trials are expected to confirm the result of this meta-analysis.

079 OUTCOMES EVALUATION OF PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION WITH CONCOMITANT CONTINUOUS RENAL REPLACEMENT THERAPY

Category: RRT Applications and Targeted Interventions Presenter: Mr PETER CHI KEUNG LAI Keywords: Extracorporeal Membrane Oxygenation, Concomitant Continuous Renal Replacement Therapy Patients on Extracorporeal Membrane Oxygenation (ECMO) often have acute kidney injury or fluid overload requiring Continuous Renal Replacement Therapy (CRRT). There was evidence that ECMO patient requiring CRRT had higher mortality due to increased severity of illness, but it is uncertain how CRRT affects outcomes of ECMO patients. To explore the characteristics of ECMO survivors who underwent concomitant CRRT. Retrospective chart review of 27 adult ECMO patients with CRRT in a university-affiliated hospital in 2015 - 2016. 12 patients had veno-venous ECMO and 15 had veno-arterial ECMO. Indications for ECMO were hypoxemic respiratory failure refractory to conventional therapy, cardiogenic shock associated with myocardial infarction, myocarditis and cardiac arrest. Mean age was 49.4±14.8 years. 9 ECMO-CRRT patients survived and 18 died. There were more patients with primary respiratory diseases in survivor group (77.8% vs 17.8%, p=0.01). Similar findings were observed between survivors and non-survivors for ECMO blood flow rate (3.96±0.56 vs 3.5±0.6, p=0.06), ECMO duration (16.7±14.1 vs 13.8±16.1, p=0.64) and length of stay in intensive care unit (ICU) (29.3±25.6 vs 15.0±17.0, p=0.16). CRRT-ECMO configuration was the same for all cases, except for one case in which CRRT was conducted with non-tunneled dialysis catheter. Indications for CRRT treatment included acute kidney injury, fluid overload and metabolic disturbance. 23 patients received systemic ECMO anticoagulation with unfractionated heparin infusion at 12-18unit/kg/hour while 4 patients in non-survivor group received regional citrate anticoagulation for CRRT. Baseline creatinine before CRRT was 327.7±233.9umol/L and percentage creatinine change was 41.4±21.2%. CRRT treatment hours (151.6±191.1 hours), total fluid removal with CRRT (12.9±18.1 liters) and number of hemofilter change (5.0±4.6) were not associated to increase in mortality. In this series of 27 patients managed with ECMO and concomitant CRRT in an adult ICU, survival to ICU discharge was 33.3%. Mortality risk was increased in patients with circulatory failure but not it was not associated with CRRT treatment modality.

Pre-operative proteinuria in left ventricular assist devices and clinical outcome

This study evaluated the association of pre-operative proteinuria before continuous flow left ventricular assist device (CF-LVAD) implantation in relation to mortality and the need for renal replacement therapy (RRT) during the first year of follow-up. This retrospective, multicenter cohort study evaluated all patients (n = 241) who underwent CF-LVAD implantation in the 2 participating tertiary referral centers. Patients were included if a urine dipstick was performed within 7 days before CF-LVAD implantation. Proteinuria was defined as trace or higher. In total, 173 patients (72%) were included (78% men; mean age, 52.3 ± 13.3; mean estimated glomerular filtration rate, 60.1 ± 25.9 mL/min/1.73 m2), and 42 patients (24%) had pre-operative proteinuria. The observed survival in patients with proteinuria vs without proteinuria was 57% vs 86% at 3 months and 52% vs 78% at 1 year (log-rank p < 0.001), respectively. In addition, during the first year after implantation, 32% of the patients with proteinuria and 15% of the patients without proteinuria required RRT (log-rank p = 0.02). Multivariate Cox regression analysis confirmed that pre-operative proteinuria was an independent predictor for mortality (adjusted hazard ratio, 2.09; 95% confidence interval, 1.10-3.80, p = 0.02) and for the need of RRT during the first year (adjusted hazard ratio, 2.23; 95% confidence interval, 1.13-4.84; p = 0.02). Proteinuria, which was present in 25% of all tested LVAD patients, predicts worse outcome in all-cause mortality and need of RRT in patients with a CF-LVAD. This warrants the use of proteinuria in risk stratification when selecting patients for CF-LVAD therapy.

Liidia Kiisk defended her doctoral thesis

"Long-term nutritional study: anthropometrical and clinico-laboratory assessments in renal replacement therapy patients aft er intensive nutritional counselling"

Effect of renin-angiotensin-aldosterone system blockade in adults with diabetes mellitus and advanced chronic kidney disease not on dialysis: a systematic review and meta-analysis.

The presumed superiority of renin-angiotensin-aldosterone system (RAAS)-blocking agents over other antihypertensive agents in patients with diabetes to delay development of end-stage kidney disease (ESKD) has recently been challenged. In addition, there is ongoing uncertainty whether RAAS-blocking agents reduce mortality and/or delay ESKD in patients with diabetes and chronic kidney disease (CKD) stages 3-5. In this subgroup, there might be an expedited need for renal replacement therapy (RRT) when RAAS-blocking agents are used. We conducted a meta-analysis of randomized controlled trials (RCTs) of at least 6-months duration in adult patients with diabetes who also have non-dialysis CKD stages 3-5. RCTs comparing single RAAS-blocking agents to placebo or alternative antihypertensive agents were included. Outcomes of interest were all-cause mortality, cardiovascular morbidity, progression of renal function, ESKD and adverse events. A total of nine trials (n = 9797 participants with CKD stages 3-5) fit our inclusion criteria. There was no difference between the RAAS group and control group regarding all-cause mortality {relative risk [RR] = 0.97 [95% confidence interval (CI) 0.85-1.10]}, cardiovascular mortality [RR = 1.03 (95% CI 0.75-1.41)] and adverse events [RR = 1.05 (95% CI 0.89-1.25)]. There was a trend for a favourable effect for non-fatal cardiovascular events [RR = 0.90 (95% CI 0.81-1.00)] and a lower risk of the composite endpoint need for RRT/doubling of serum creatinine [RR = 0.81 (95% CI 0.70-0.92)] in the RAAS-blocking agents group versus the control group. We found evidence that in patients with diabetes mellitus and CKD stages 3-5, treatment with RAAS-blocking agents did not result in a clear survival advantage. The effect on renal outcomes did depend on the selected outcome measure. However, we did not find evidence that the use of RAAS-blocking agents expedited the need for RRT in patients with CKD stages 3-5.

Early and Late Patient Outcomes in Urgent-Start Peritoneal Dialysis.

Significant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start. This single-center, matched case-control study evaluated patients commencing PD between 2010 and 2015. Urgent-start PD patients were matched 1:3 with conventional-start PD controls based on diabetic status and age. The primary outcomes were early complications, both following catheter insertion and PD commencement (within 4 weeks). Secondary outcomes included technique and peritonitis-free survival. A total of 104 patients (26 urgent-start, 78 conventional-start) were included. Urgent-start patients were more likely to be referred late, initiate PD in hospital, and be prescribed lower initial exchange volumes (p < 0.01). They experienced more frequent leaks post-catheter insertion (12% vs 1%, p = 0.047) and more frequent catheter migration following commencement of PD (12% vs 1%, p = 0.047). There were no significant differences in the rates of overall or infectious complications. Kaplan-Meier estimates of technique survival and time to first episode of peritonitis were comparable between the groups. Compared with conventional-start PD, urgent-start PD has acceptably low early complication rates and similar long-term technique survival. Urgent-start PD appears to be a safe way to initiate urgent renal replacement therapy in patients without established dialysis access.

A Study on Prevalence of Left Ventricular Dysfunction And its Correlation With Estimated Glomerular Filtration Rate (Egfr) In Ckd Patients

BACKGROUND AND OBJECTIVE: In Chronic Kidney Disease there is a higher incidence cardiovascular events. Most of the patients with CKD succumb to cardiovascular disease even before they reach the end stage of renal disease. Hence all efforts should be given in earlier stages of CKD to prevent the development of cardiovascular complications. LV diastolic dysfunction is found to antedate LVH and systolic dysfunction. It is not just associated with hemodynamic factors like anaemia and hypertension, but also with uraemia related non hemodynamic factors like secondary hyperparathyroidism, altered mineral metabolism, cardiotrophysin etc. ECHO provides a simple non-invasive method to assess the left ventricular structure and function, which helps us in identifying those prone for cardiovascular complications at an earlier stage of CKD. This study was done to find out the prevalence of LV dysfunction and its correlation with eGFR in CKD patients. METHODS: 50 hypertensive CKD patients and 50 normotensive CKD patients admitted to Government Rajaji Hospital between May 2013 to August 2014 were evaluated for the presence of LV dysfunction and LVH and the results were compared with that of 50 age and sex matched individuals. Patients with acute kidney injury, prior coronary artery disease, valvular heart disease, cardiomyopathy, diabetic individuals and CKD patients on renal replacement therapy or transplant patients were excluded from the study. The CKD patients were divided into various stages of CKD based on their eGFR (calculated according to MDRD formula) and they were evaluated by ECHO. Those with an ejection fraction 2 was grade III diastolic dysfunction. This was compared with the ECHO findings of the controls. The collected data was analysed using various statistical methods. RESULTS: 74% of CKD patients had LV diastolic dysfunction (p <0.0001). Diastolic dysfunction was found to occur in 84% of the hypertensive CKD and in 64% of the normotensive CKD (p=0.02). Comparing the CKD normotensives with the control group, 64% among the normotensive CKD had diastolic dysfunction whereas only16% of controls had diastolic dysfunction (p<0.05). There is a negative correlation between the eGFR and diastolic dysfunction. So as the eGFR falls, the diastolic dysfunction increases. INTERPRETATION AND CONCLUSION: Even in the absence of hypertension, LV diastolic dysfunction can occur in CKD. This emphasizes the need for correction of not just hemodynamic factors but also the uraemia related factors.

One- and 2-Year Mortality Prediction for Patients Starting Chronic Dialysis

IntroductionMortality risk of patients with end-stage renal disease (ESRD) is highly elevated. Methods to estimate individual mortality risk are needed to provide individualized care and manage expanding ESRD populations. Many mortality prediction models exist but have shown deficiencies in model development (data comprehensiveness, validation) and in practicality. Therefore, our aim was to design 2 easy-to-apply prediction models for 1- and 2-year all-cause mortality in patients starting long-term renal replacement therapy (RRT).MethodsWe used data from the Finnish Registry for Kidney Diseases with complete national coverage of RRT patients. Model training group included all incident adult patients who started long-term dialysis in Finland in 2000 to 2008 (n = 4335). The external validation cohort consisted of those who entered dialysis in 2009 to 2012 (n = 1768). Logistic regression with stepwise variable selection was used for model building.ResultsWe developed 2 prognostic models, both of which only included 6 to 7 variables (age at RRT start, ESRD diagnosis, albumin, phosphorus, C-reactive protein, heart failure, and peripheral vascular disease) and showed sufficient discrimination (c-statistic 0.77 and 0.74 for 1- and 2-year mortality, respectively). Due to a significantly lower mortality in the newer cohort, the models, to a degree, overestimated mortality risk.DiscussionMortality prediction algorithms could be more widely implemented into management of ESRD patients. The presented models are practical with only a limited number of variables and fairly good performance.

End-stage kidney disease in patient with epidermolysis bullosa - what are the treatment options? \u2013 case report

BackgroundEpidermolysis bullosa is a group of diseases caused by mutations in genes for proteins responsible for cells’ anchorage at the dermo-epidermal junction. Their common feature are dysfunctional or even absent connections between cells. The typical clinical sign is the formation of blisters, with possible excessive scarring, in response to minimal skin irritation. End stage renal disease may be one of the comorbidities in patients with epidermolysis bullosa. The implementation of renal replacement therapy may be very difficult in this population. This is mainly due to problems in obtaining the proper dialysis access. The choice of appropriate method may be crucial for patient’s survival.Case presentationWe present a case of 29-year-old woman with Epidermolysis bullosa caused by laminin 5 gene mutation. The patient suffered from additional conditions: blindness, complete bilateral sensorineural deafness and oesophageal stenosis. When end stage renal disease was diagnosed, the problem of renal replacement therapy had to be faced. There have been few reports concerning ESRD in this specific group of patients in the available literature. In most of them the prognosis was very poor. Nevertheless, we were very determined to overcome all the difficulties. Special procedures and cooperation with the patient’s family allowed us to consider kidney transplantation as a treatment option.ConclusionThere should be no limitations in renal replacement therapy in patients with epidermolysis bullosa. Haemodialysis, peritoneal dialysis and kidney transplantation are all possible treatment options. Nevertheless, either method requires special procedures.